Clinical - Care Manager - J01006

Job Title: Clinical - Care Manager

Location: Remote- KS 75% Travel

Ideal Candidate would be located in: Central KS- Salina, Hutchinson, Great Bend, Pratt, and surrounding area.

Duration: 6months (Possibility to extend or convert)

Work schedule: 8am-5pm | with possibility of some evening's hours due to business need

Pay Range: XXXXXXXXXXX to XXXXXXXXXXX/hr. on w2

Position Purpose:

Develops, assesses, and facilitates complex care management activities for primarily mental and behavioral health needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families related to mental health and substance use disorder.

License/Certification:

For Illinois Youth Care plan only: Graduate degree and independently licensed behavioral health clinician (e.g. LCSW, LCPC, PsyD) in Illinois or Bachelor's Degree and IL RN licensure. Must reside in IL required.

For NJ Health Plan Only: Requires a Master's degree in Behavioral Health or Social Work and a Licensed Associate Counselor (LAC) or Licensed Social Worker (LSW) required.

For (FL) Only: Employees supporting Florida's Children's Medical Services Must Hold a Master's degree in social work or related field and have one year of related professional pediatric care experience. May require up to 80% local travel required.

Responsibilities:

• Evaluates the needs of the member via phone or in-home visits related to the resources available, and recommends and/or facilitates the care plan/service plan for the best outcome, which may include behavioral health and social determinant needs.
• May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources.
• Develops ongoing care plans for members with high level acuity and works to identify providers, specialists, and community resources needed for care including mental health and substance use disorders.
• Coordinates as appropriate between the member and/or family/caregivers, community resources, and the care provider team to ensure identified services are accessible to members.
• Monitors care plans/service plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and provides recommendations to care plan/service plan based on identified member needs.
• Facilitates care coordination and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services.
• Collects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
• Provides education to members and their families on procedures, healthcare provider instructions, treatment options, referrals, and healthcare benefits, which may include behavioral health and social determinant needs.
• Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner.
• Performs other duties as assigned.
• Complies with all policies and standards.

Day to day duties include:

• 48hr in- person visits following a placement change for the member.
• 7-Day team meetings following a placement change for the member.
• Telephonic outreaches based on member's acuity.
• In-person visits based on member's acuity.
• Annual assessments.
• In-person visits that may take place after 5pm Weekly team meetings

Performance Expectations

Success in this role will be measured by:

• Timely completion of Health Risk Assessments .
• Timely completion and maintenance of Plans of Service/care plans .
• Completion of required in-person visits and outreach activities.
• Compliance with state, federal, contractual, and regulatory requirements.
• Quality and accuracy of documentation.
• Effective coordination and accessibility of required member services.
• Ability to meet the accelerated timelines associated with foster care placement changes

Required Qualifications:

Education

• Master's degree in Behavioral Health or Social Work, OR
• Degree from an accredited School of Nursing.

Experience

• 2 4 years of related experience preferred/required based on applicable role requirements.
• At least 1 year of experience coordinating services across child welfare and related systems of care is required.
• Experience working with children and families in foster care or child welfare settings is highly important .

Licensure:

• Required: Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience required

Disqualifiers: no experience working in child welfare and related systems of care.

Additional qualities to look for: strong communication, high-quality documentation, adaptability/flexibility, and solution focused.

Top 3 must-have hard skills stack-ranked by importance:

1. Required behavioral health/social work or nursing education and appropriate licensure.
2. Experience coordinating services across child welfare and related systems of care, particularly foster care.
3. Strong communication, documentation, adaptability, and solution-focused problem-solving skills.